(RxWiki News) Almost one in five preschool children experience bedwetting at some point. Even though most grow out of it, it's not a picnic for the child or parents.
A recent study found that a variety of behavioral treatments can be effective to help reduce bedwetting.
One such treatment involves reward charts in which children are rewarded for dry nights. Another is waking the child up at least once a night to have them use the bathroom.
The most effective therapy, if these simpler ones fail, is the use of a bedwetting alarm.
"Try simple behavioral treatments for bedwetting first."
This study, led by Patrina Caldwell, of The Children's Hospital at Westmead Clinical School at the University of Sydney in Australia, looked at which behavioral treatments were effective for bedwetting in children.
The authors of this study noted that there are two basic types of behavioral interventions: simple and complex. This review focused on simple ones, which the child primarily does and requires little effort.
The researchers searched three medical research databases plus conference presentations for studies related to behavioral interventions for bedwetting in kids up to age 16.
They identified 16 studies involving a total of 1,643 children. Of these, 865 participated in a specific behavioral intervention.
The researchers found that three simple behavioral interventions were all more effective in reducing nights with bedwetting when compared to no intervention.
These interventions included rewards, lifting and waking and bladder training.
Rewards refers to reward systems like sticker charts in which children get a sticker or star for each dry night.
Lifting and waking involves the parent waking the child up in the night to have them go to the bathroom.
Bladder training, which should be discussed or supervised by a doctor, involves helping a child learn to hold their urine for longer periods to enlarge the size of the bladder.
Each of these methods also involved success for more children than no intervention at all, and fewer children using these methods relapsed.
However, these simple behavioral interventions were not as effective as more involved interventions that are already known to be effective, such as alarm therapy and the use of medications like imipramine and amitriptyline.
Alarm therapy involves using a special bedwetting alarm that senses moisture. As soon as a person starts to urinate, the alarm goes off, training the brain to get up to use the bathroom when the bladder is full.
Bedwetting alarms range in price from about $15 to over $150.
One drawback to using medications, the researchers found, was that the success in not bedwetting did not continue after the course of medications was finished.
One of the studies found that cognitive therapy was more effective than a reward system for children.
Cognitive therapy involves retraining the brain's response to certain emotions or physical sensations. It is done with the help of a trained therapist or psychologist.
Aside from this finding about cognitive therapy, the other simple behavioral interventions all seemed to have similar success rates.
"Simple behavioral methods may be superior to no active treatment but appear to be inferior to [bedwetting] alarm therapy and some drug therapy," the authors wrote.
"Simple behavioral therapies could be tried as first line treatment before considering [bedwetting] alarm therapy or drug therapy, which may be more demanding and have adverse effects, although evidence supporting their [effectiveness] is lacking," they wrote.
Thomas Seman, MD, a pediatrician at North Shore Pediatrics in Danvers, Mass., said this is a common issue he sees in his practice.
"I agree that the behavioral changes are the best," Dr. Seman said. "They start a routine which the body and the mind of a young child appreciate."
Behavioral changes include paying attention to what a child consumes before bedtime.
"Frequently we will limit fluid intake by around supper time and further restrict after that," Dr. Seman said. "Awakening the child at night before the parent goes to bed is very helpful."
Dr. Seman said his practice has not seen ideal results from using an alarm.
"Children who wet the bed are often very deep sleepers, and typically the alarm does not awaken the child but will awaken the parents and whomever else is in the house," he said. "However, should the child awaken with the alarm, they are very effective."
He also said using medications is not a common treatment.
"In the US we rarely use the medications mentioned in the study due to some side effects or the need to monitor more closely," Dr. Seman said. "We do use another medication that works well and that I have had very good luck with in stopping the bedwetting even after the medication is discontinued."
Dr. Seman also emphasized the importance of ensuring that doctors have ruled out other issues that might be affecting the child.
"A child should be evaluated by a physician before implementing bedwetting strategies to make sure there are no other significant issues present," he said.
This study was published July 19 in The Cochrane Library. The research was funded by the National Institute for Health Research in the United Kingdom. The authors declared no conflicts of interest.